Outline

Objective: The aim of our study was to present the results of intraventricular injection of recombinant tissue-type plasminogen activator (rtPA) in patients suffering from intraventricular hemorrhage (IVH).

Method: Patients with spontaneous IVH were enrolled in the study during 2006-2010. A rigid external ventricular drainage (EVD) was implanted via left or right sided frontal burr holes. 3mg rtPA was injected each day over the EVD for three consecutive days. Hemorrhage size was determined by daily CT scanning. Classification of IVH was done using the IVH scoring system developed by Hijdra et al.. The clinical condition was classified using the Glasgow coma scale (GCS) and Glasgow outcome scale (GOS). Statistical analysis (Analysis of Variance (ANOVA) and χ2-Test) was done for various parameters to analyze their impact on morbidity and mortality.

Results: Eighty patients were included to the study (45 male, 35 female). Most of the patients were in the sixth decade of life. At time of admission 49 patients (56.3%) were in a poor (GCS <8), 14 (17.5%) in an intermediate (GCS 9-12) and 17 (21.3%) in a good condition (GCS >13). Except of statistical outliers, which reduced the total results (average 45.1%; range: 0-100%), clot lysis with rtPA reduced the hematoma size significantly. In the majority of all cases clot lysis could reach a reduction of over 66%. However, clot lysis alone did not lead to a statistically significant reduction of morbidity and mortality (p >0.05). Multivariate analysis showed a statistically significant correlation of poor GCS grade, old age and initial high Hijdra score to a poor outcome (p<0.05). Clot lysis affected the outcome positively especially in the group with age <70 years, GCS >9 and a Hijdra score <8.

Conclusions: Intraventricular application of rt-PA as a minimal invasive treatment modality seems to be suitable for clearance of the blood clots from the ventricles. Despite our mainly good and successful volume reduction, clot lysis alone did not influence the outcome positively. Its usage should be considered in view of different predictive factors. Large Prospective and randomized trials are necessary to answer the open questions.